16 COGNITIVE THEORY AND RESEARCH ON ANXIETY
biologiCal aspeCts of anxietyAnxiety is multifaceted, involving diverse elements of the physiological, cognitive,
behavioral, and affective domains of human function. Table 1.3 lists the symptoms of
anxiety divided into the four functional systems involved in an adaptive response to
threat and danger (Beck et al., 1985, 2005).
The automatic physiological responses that typically occur in the presence of threat
or danger are considered defensive responses. These responses, seen in the fear- eliciting
contexts of both animals and humans, involve autonomic arousal that prepares the
organism to deal with danger by fleeing (i.e., flight) or by directly confronting the danger
(i.e., fight), a process known as the “fight-or- flight” response (Canon, 1927). The behav-
ioral features primarily involve escape or avoidance as well as safety- seeking responses.
The cognitive variables provide the meaningful interpretation of our internal state as
that of anxiety. Finally the affective domain is derived from cognitive and physiological
activation, and constitutes the subjective experience of feeling anxious. In the follow-
ing sections, we briefly discuss the physiological, behavioral, and emotional aspects of
anxiety. The cognitive features of anxiety are the focus of subsequent chapters.
Psychophysiology
As evident from Table 1.3, many of the symptoms of anxiety are physiological in nature,
reflecting activation of the sympathetic (SNS) and parasympathetic (PNS) nervous sys-
tems. Activation of the SNS is the most prominent physiological response in anxiety,
and it leads to hyperarousal symptoms such as constriction of the peripheral blood
vessels, increased strength of the skeletal muscles, increased heart rate and force of con-
traction, dilation of the lungs to increase oxygen supply, dilation of the pupils for pos-
sible improved vision, cessation of digestive activity, increase in basal metabolism, and
increased secretion of epinephrine and norepinephrine from the adrenal medulla (Brad-
table 1.3. Common features of anxiety
Physiological symptoms
(1) Increase heart rate, palpitations; (2) shortness of breath, rapid breathing; (3) chest pain or pressure;
(4) choking sensation; (5) dizzy, lightheaded; (6) sweaty, hot flashes, chills; (7) nausea, upset stomach,
diarrhea; (8) trembling, shaking; (9) tingling or numbness in arms, legs; (10) weakness, unsteady,
faintness; (11) tense muscles, rigidity; (12) dry mouth
Cognitive symptoms
(1) fear of losing control, being unable to cope; (2) fear of physical injury or death; (3) fear of “going
crazy”; (4) fear of negative evaluation by others; (5) frightening thoughts, images, or memories; (6)
perceptions of unreality or detachment; (7) poor concentration, confusion, distractible; (8) narrowing of
attention, hypervigilance for threat; (9) poor memory; (10) difficulty in reasoning, loss of objectivity
Behavioral symptoms
(1) avoidance of threat cues or situations; (2) escape, flight; (3) pursuit of safety, reassurance; (4)
restlessness, agitation, pacing; (5) hyperventilation; (6) freezing, motionless; (7) difficult speaking
Affective symptoms
(1) nervous, tense, wound-up; (2) frightened, fearful, terrified; (3) edgy, jumpy, jittery; (4) impatient,
frustrated